Osteochondrosis of the capitellum is a condition where a segment of subchondral bone and overlying cartilage separate from the elbow. It typically affects adolescent boys and is caused by repeated minor injuries. Early stages show intact or slightly discolored cartilage, while later stages have a ragged capitellum surface and loose bodies in the joint. Treatment involves rest initially, while surgical removal of loose bodies or fragment fixation may be needed for persistent symptoms. Arthroscopic surgery is now preferred over open procedures.

1. Osteochondrosis of Capitellum
Presented by Dr Yash Oza
Moderator Dr Umesh Jain

2. • In Osteochondrosis of Capitellum a small segment
of subchondral bone slowly separate from its bed.
• The overlying articular cartilage also slowly
separate & osseocartilaginous body is extruded
into the joint cavity.

3. Etiology
• Repeated minor injuries
• Incidence is common in gymnasts & baseball players

4. Pathology
• Early stage, the overlying cartilage is intact, normal
or slightly discolored.
• Later stage, the surface of capitellum is ragged & a
flap of cartilage may over hang.
One or many loose body may be found in joint
cavity.
Largest loose body consist of a center of bone &
covering hyaline cartilage.
Smaller ones are made of only cartilage. ( not
visible on xray.

5. • Radial head enlarged posterolateraly. And
metaphysis is often funnel shaped
• There is a premature fusion of epiphysis.

6. Clinical Presentation
• Age group : usually occurs after age 10 (typically
adolescents)
• boys more common than girls
• Right elbow more often involved, also may be
bilateral
• Insidious in onset
• First symptom include – dull ache and little stiffness
in elbow.
• History of repetitive trauma is also there.
• Pain subsides by rest.

7. • Locking or catching of the joint suggest the
presence of loose bodies within the joint.
• Condition may be silent and discovered accidently
by limitation of elbow extension & large radial
head.
• After a painfree period there is sudden onset of
spontaneous locking & pain followed by effusion.

8. Panner's disease
• It is a similar condition with slightly different
presentation
• osteochondrosis of the capitellum
• typically presents in first decade of life (<10 years old)
• usually benign self-limiting course
• same mechanism of injury as OCD
• surgery is contraindicated for Panner disease (unlike
OCD elbow)

9. Radiological finding
• Anteroposterior and lateral radiographs should be
obtained, and comparison views of the
contralateral elbow are helpful to identify subtle
changes in the capitellum.

10. Radiographic and Arthroscopic Classification
Type I Intact cartilage
Bony stability may
(Type Ia) or
may not be
present (type Ib)
Type II Cartilage fracture with
bony collapse or
displacement
Type III Loose bodies present
in joint

11. • MRI often identifies early changes of marrow
edema before changes are seen on plain
radiographs.
• Recent studies revealed that MRI could reliably
predict instability of an elbow lesion.

12. Conservative Treatment
• If a loose body is not present, nonsurgical
treatment usually is satisfactory, especially if the
lesion seems stable (type Ia).
• Resting the joint for 3 to 6 weeks with the use of a
hinged elbow brace to eliminate excessive stress
• Usually allows return to activity in 3 to 6 months.

13. Surgical Treatment
• Indications for operative treatment include
• persistent symptoms,
• symptomatic loose bodies,
• fracture of the articular cartilage, and
• displacement of the osteochondral lesion.
• Operative management may involve
• excision of loose bodies or partially attached lesions,
• chondroplasty with osteochondral autogenous graft
(mosaicplasty),
• subchondral drilling, or
• internal fixation of a loose fragment.
Mixed results have been reported for all of these techniques, with rates of poor results up to 50%.

14. OPEN APPROACH FOR FRAGMENT
REMOVAL
■ Done by posterolateral approach.
■ Make a 4 to 6 cm posterolateral oblique skin
incision on a line from the posterior edge of the
lateral epicondyle to the posterior aspect of the
radioulnar joint.
■ Incise the capsule over the capitellar lesion and
elongate the incision from the posterior edge of the
lateral epicondyle to the posterior aspect of the
radioulnar joint.
■ Perform a limited local synovectomy to remove
fragments.

15. • In more recent literature, ARTHROSCOPIC
techniques gives better results.
• Arthroscopic procedures include
• partial synovectomy,
• excision of loose bodies,
• drilling the crater or the intact lesion, microfracture,
• internally fixing the unstable viable fragment
(mosaicplasty) with bioabsorbable pins
• osteotomy of the capitellum.
• Although the arthroscopic results seem to be better
than nonarthroscopic techniques, no procedure,
ensures return to a throwing sport, such as
baseball. - Byrd and Jones

16. ARTHROSCOPIC FRAGMENT REMOVAL
■ Inject 10 to 20 mL of 1% lidocaine with epinephrine
into the elbow joint.
■ Flex the shoulder 90 degrees and elevate the elbow
until the upper arm is almost vertical.
■ Create posterior, posterolateral, anteromedial, and
anterolateral portals with a sharp blade.
■ Bluntly release the subcutaneous tissues avoiding the
cutaneous nerves.
■ Widen the portals with the use of step-up cannulas.
■ Insert an arthroscope to remove the loose bodies.

17. RECONSTRUCTION USING BONE
PLUG GRAFTS
 After removal of loose fragments
arthroscopically or through an open
approach, harvest cylindrical
osteochondral bone plugs from the
lateral part of the lateral femoral
condyle
 One to three plugs may be
necessary depending on the size of
the defect.
 Prepare the recipient bed.
 Place the osteochondral plugs
toward the center of the capitellum
to obtain stable fixation.

18. POSTOPERATIVE CARE.
• Immobilize the elbow for 1 to 2 weeks and
• Protect the knee from vigorous flexion for 3 weeks.
• 3 months after the procedure, gentle elbow
exercises against resistance are progressed to full
resistance at 4 months.
• Throwing is allowed at 4 to 5 months if there is no
pain and elbow range of motion has returned to
preoperative levels.
• The patient is released for full sports activity at 6 to
8 months.